Obstetric care in the Netherlands: Regional differentiation in home delivery

Abstract

In this paper attention is focused on home delivery in the Netherlands, which still accounts for 36% of the total number of births delivered. Compared to countries with a similar level of socio-economic development, home delivery plays an important role within Dutch obstetric care. To understand this unique situation, one needs to have insight into the organization and structure of Dutch obstetric care which is described in the first part of this paper. In the second part of this paper regional differentiation in the relative importance of home delivery is described. Finally regression analysis is used in order to explain the observed regional pattern. A brief abstract from the vast amount of Dutch literature on the discussion between advocates and adversaries of home delivery is included in an appendix.

Medical or health geography? Populations, peoples and places

“…In Senior and Williamson's (1990) study, geographical factors such as accessibility, mobility and the space±time constraints of employment were less important than personal factors such illness, bereavement and holidays in explaining cervical cytology screening uptake. Hingstman and Boon (1988) used an ecological analysis to understand the regional variation in home births in the Netherlands. The level of urbanisation, as captured in the negative relationships between the dependent variable and independent variables, supply of hospital beds and population density, was used to provide an explanation for the geographical patterns observed.…”

Maternity Care in The Netherlands: The Changing Home Birth Rate

“…Thus, women were offered the opportunity of giving birth in hospital with their own midwife or general practitioners and returning home within 24 hours after birth. As a consequence of this and insurance policies relating to postpartum hospital stay, the share of short‐stay hospital births among the total number of births increased over the 1970 to 1983 period from 2.5 to 36 percent (5 ).…”

“…Of all women whose birth was supervised by an obstetrician in the early 1980s, it has been estimated that 50 percent were referred in pregnancy or during childbirth, whereas the remaining 50 percent were under specialist care since early pregnancy (11 ). The marked increase in the share of obstetricians in maternity care also relates to the numerical growth in that profession: between 1970 and 1983 the number of practicing obstetricians increased by 53 percent (5 ), whereas the number of practicing midwives increased by only 11 percent in the same period (13 ).…”

“…As previously, large regional differences are still present, however, with home birth rates varying from 41 percent in rural provinces to 26 percent in urbanized provinces. Examining the reasons for these differences, Hingstman and Boon (5 ) found that urbanization, including population density and available hospital facilities, was the most important explanation, with the highest home birth rates being encountered in the least urbanized areas. More recent data confirm this, showing that the average home birth rate in municipalities with 100,000 or more inhabitants was only 21.3 percent in 1992, but the average rate was 39.5 percent in those with fewer than 5000 inhabitants (9 ).…”

Organization of Prenatal Care in Belgium

“…Whatever the reason, Belgium, and Wallonia and Brussels in particular, hold a special place in Europe because of the importance gynecologists have achieved as first-level spe cialists. In France for example, such first-level specialists supervise (in an exclusive capacity) only 38.2% of all pregnancies; but, working largely in a mixed system, they participate in 79.5% cases of prenatal care for pregnant women overall (38.2% exclusive care and 41.3% mixed care) [24], As to other European countries, it is worth mentioning Scandinavia and Holland on the one hand, where care is provided by midwives and GPs (60% of preg nancies are supervised by these two practitio ners) [2,8,16], and the United Kingdom on the other, where 81% of the women go to hospital for a visit at least once during their pregnancy, but use a mixed system based on care supervision by their GP [2], Table II. Prenatal care options: results of studies Despite the absence of legislation for compulsory examination, there is a high level of prenatal care coverage in Belgium, where studies show that only 0.5% of the pregnancies are not supervised [30].…”